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	AccessMedicine | Breast Cancer Screening
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																			<b>Sections in this chapter:</b><br>
																			<span id="ctl00_divMainContentWrapper_lblSections"><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td valign="top" width="100%"><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td width="0"><img src="Chapter%2012.%20Breast%20Disease_archivos/spacer.gif" height="1" width="0"></td><td class="quickLinkNav" width="100%"><br class="Spacer5"><img src="Chapter%2012.%20Breast%20Disease_archivos/bullet_ql.gif" align="absmiddle" border="0"><a href="http://www.accessmedicine.com/content.aspx?aID=3169982">Breast Disease: Introduction</a></td></tr></tbody></table><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td width="0"><img src="Chapter%2012.%20Breast%20Disease_archivos/spacer.gif" height="1" width="0"></td><td class="quickLinkNav" width="100%"><br class="Spacer5"><img src="Chapter%2012.%20Breast%20Disease_archivos/bullet_ql.gif" align="absmiddle" border="0"><a href="http://www.accessmedicine.com/content.aspx?aID=3154770">Anatomy</a></td></tr></tbody></table><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td width="0"><img src="Chapter%2012.%20Breast%20Disease_archivos/spacer.gif" height="1" width="0"></td><td class="quickLinkNav" width="100%"><br class="Spacer5"><img src="Chapter%2012.%20Breast%20Disease_archivos/bullet_ql.gif" align="absmiddle" border="0"><a href="http://www.accessmedicine.com/content.aspx?aID=3154783">Development and Physiology</a></td></tr></tbody></table><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td width="0"><img src="Chapter%2012.%20Breast%20Disease_archivos/spacer.gif" height="1" width="0"></td><td class="quickLinkNav" width="100%"><br class="Spacer5"><img src="Chapter%2012.%20Breast%20Disease_archivos/bullet_ql.gif" align="absmiddle" border="0"><a href="http://www.accessmedicine.com/content.aspx?aID=3154787">Evaluation of a Breast Lump</a></td></tr></tbody></table><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td width="0"><img src="Chapter%2012.%20Breast%20Disease_archivos/spacer.gif" height="1" width="0"></td><td class="quickLinkNav" width="100%"><br class="Spacer5"><img src="Chapter%2012.%20Breast%20Disease_archivos/bullet_ql.gif" align="absmiddle" border="0"><a href="http://www.accessmedicine.com/content.aspx?aID=3154906">Nipple Discharge</a></td></tr></tbody></table><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td width="0"><img src="Chapter%2012.%20Breast%20Disease_archivos/spacer.gif" height="1" width="0"></td><td class="quickLinkNav" width="100%"><br class="Spacer5"><img src="Chapter%2012.%20Breast%20Disease_archivos/bullet_ql.gif" align="absmiddle" border="0"><a href="http://www.accessmedicine.com/content.aspx?aID=3154982">Breast Infections</a></td></tr></tbody></table><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td width="0"><img src="Chapter%2012.%20Breast%20Disease_archivos/spacer.gif" height="1" width="0"></td><td class="quickLinkNav" width="100%"><br class="Spacer5"><img src="Chapter%2012.%20Breast%20Disease_archivos/bullet_ql.gif" align="absmiddle" border="0"><a href="http://www.accessmedicine.com/content.aspx?aID=3154993">Mastalgia</a></td></tr></tbody></table><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td width="0"><img src="Chapter%2012.%20Breast%20Disease_archivos/spacer.gif" height="1" width="0"></td><td class="quickLinkNav" width="100%"><br class="Spacer5"><img src="Chapter%2012.%20Breast%20Disease_archivos/bullet_ql.gif" align="absmiddle" border="0"><a href="http://www.accessmedicine.com/content.aspx?aID=3154999">Benign Proliferative Breast Disease</a></td></tr></tbody></table><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td width="0"><img src="Chapter%2012.%20Breast%20Disease_archivos/spacer.gif" height="1" width="0"></td><td class="quickLinkNav" width="100%"><br class="Spacer5"><img src="Chapter%2012.%20Breast%20Disease_archivos/bullet_ql.gif" align="absmiddle" border="0"><a href="http://www.accessmedicine.com/content.aspx?aID=3155007">Lobular Carcinoma In Situ</a></td></tr></tbody></table><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td width="0"><img src="Chapter%2012.%20Breast%20Disease_archivos/spacer.gif" height="1" width="0"></td><td class="quickLinkNav" width="100%"><br class="Spacer5"><img src="Chapter%2012.%20Breast%20Disease_archivos/bullet_ql.gif" align="absmiddle" border="0"><a href="http://www.accessmedicine.com/content.aspx?aID=3155010">Ductal Carcinoma In Situ</a></td></tr></tbody></table><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td width="0"><img src="Chapter%2012.%20Breast%20Disease_archivos/spacer.gif" height="1" width="0"></td><td class="quickLinkNav" width="100%"><br class="Spacer5"><img src="Chapter%2012.%20Breast%20Disease_archivos/bullet_ql.gif" align="absmiddle" border="0"><a href="http://www.accessmedicine.com/content.aspx?aID=3155028">Breast Cancer Risk Factors</a></td></tr></tbody></table><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td width="0"><img src="Chapter%2012.%20Breast%20Disease_archivos/spacer.gif" height="1" width="0"></td><td class="quickLinkNav" width="100%"><br class="Spacer5"><img src="Chapter%2012.%20Breast%20Disease_archivos/bullet_ql.gif" align="absmiddle" border="0"><b><font color="#990000">Breast Cancer Screening</font></b></td></tr></tbody></table><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td width="0"><img src="Chapter%2012.%20Breast%20Disease_archivos/spacer.gif" height="1" width="0"></td><td class="quickLinkNav" width="100%"><br class="Spacer5"><img src="Chapter%2012.%20Breast%20Disease_archivos/bullet_ql.gif" align="absmiddle" border="0"><a href="http://www.accessmedicine.com/content.aspx?aID=3155092">Invasive Breast Cancer</a></td></tr></tbody></table><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td width="0"><img src="Chapter%2012.%20Breast%20Disease_archivos/spacer.gif" height="1" width="0"></td><td class="quickLinkNav" width="100%"><br class="Spacer5"><img src="Chapter%2012.%20Breast%20Disease_archivos/bullet_ql.gif" align="absmiddle" border="0"><a href="http://www.accessmedicine.com/content.aspx?aID=3155208">Breast Cancer Prevention</a></td></tr></tbody></table><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td width="0"><img src="Chapter%2012.%20Breast%20Disease_archivos/spacer.gif" height="1" width="0"></td><td class="quickLinkNav" width="100%"><br class="Spacer5"><img src="Chapter%2012.%20Breast%20Disease_archivos/bullet_ql.gif" align="absmiddle" border="0"><a href="http://www.accessmedicine.com/content.aspx?aID=3155213">References</a></td></tr></tbody></table><table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td class="quickLinkNav" width="0"><br><a href="javascript:windowReference('Print','popup.aspx?aID=3155078&amp;print=yes_chapter');" class="navlinks" style="text-decoration: none; white-space: nowrap;"><b>View/Print Entire Chapter</b> </a></td></tr></tbody></table><br class="Spacer10"></td><td width="10"><img src="Chapter%2012.%20Breast%20Disease_archivos/spacer.gif" height="1" width="10"></td></tr></tbody></table></span>
																			
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																			<b>SEE ALSO</b> on AccessMedicine<br>
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																			<span id="ctl00_divMainContentWrapper_lblRelated"> - <a href="http://www.accessmedicine.com/search/searchAMResult.aspx?searchType=1&amp;rootTerm=breast+diseases&amp;rootID=15555">breast diseases</a><br> - <a href="http://www.accessmedicine.com/search/searchAMResult.aspx?searchType=1&amp;rootTerm=breast+neoplasm+screening&amp;rootID=47008">breast neoplasm screening</a><br> - <a href="http://www.accessmedicine.com/search/searchAMResult.aspx?searchType=1&amp;rootTerm=magnetic+resonance+imaging+of+breast&amp;rootID=45710">magnetic resonance imaging of breast</a><br> - <a href="http://www.accessmedicine.com/search/searchAMResult.aspx?searchType=1&amp;rootTerm=mammography&amp;rootID=23122">mammography</a><br> - <a href="http://www.accessmedicine.com/search/searchAMResult.aspx?searchType=1&amp;rootTerm=physical+breast+examination&amp;rootID=47469">physical breast examination</a><br> - <a href="http://www.accessmedicine.com/search/searchAMResult.aspx?searchType=1&amp;rootTerm=ultrasonography%2c+mammary&amp;rootID=30745">ultrasonography, mammary</a><br></span>
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				<td class="navlinks" align="center" width="100%"><a id="ctl00_divMainContentWrapper_lnkPreviousTop" href="http://www.accessmedicine.com/content.aspx?aID=3155028"><font class="font12noMargin">&lt;</font>&nbsp;<b>Previous 
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																			<span id="ctl00_divMainContentWrapper_lblSectionTitle" class="contentHead1"></span>
																			
																			
																			
																			<span id="ctl00_divMainContentWrapper_lblContent"><link rel="stylesheet" href="Chapter%2012.%20Breast%20Disease_archivos/Global.css" type="text/css" media="screen" title="LMS main style sheet" xmlns:mbp="http://apache.org" xmlns:idx="http://www.w3.org" xmlns:msxml="urn:schemas-microsoft-com:xslt"><a name="3155078" external="yes" xmlns:mbp="http://apache.org" xmlns:idx="http://www.w3.org" xmlns:msxml="urn:schemas-microsoft-com:xslt"></a><p class="contentHead1" xmlns:mbp="http://apache.org" xmlns:idx="http://www.w3.org" xmlns:msxml="urn:schemas-microsoft-com:xslt">Breast Cancer Screening</p><a name="3155078"></a><table xmlns:mbp="http://apache.org" xmlns:idx="http://www.w3.org" xmlns:msxml="urn:schemas-microsoft-com:xslt" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td bgcolor="#ffffff" valign="top" width="100%"><a name="3155079"></a><p class="contentHead2">Screening <font color="#990000"><b><a name="searchTerm"></a>Mammography</b></font></p><a name="3155080"></a><p class="contentBody">This
radiographic test is currently the best available and most thoroughly
validated breast cancer screening test available. It has been evaluated
in eight large randomized trials, the most recent of which was
conducted in Canada in the 1980s (<a href="http://www.accessmedicine.com/content.aspx?aID=3155213#3155213" target="_parent">Begg, 2002</a>). Controversies surrounding the benefits of screening <font color="#990000"><b><a name="searchTerm"></a>mammography</b></font>
largely center on the impact of the test on breast cancer–specific and
overall mortality. However, at this time, it is generally accepted that
for women aged 50 to 69 years, screening <font color="#990000"><b><a name="searchTerm"></a>mammography</b></font>
reduces breast cancer mortality. Considerable uncertainty remains for
women between the ages of 40 and 49, but several influential
organizations including the American Cancer Society, the American
Medical Association, and the American College of Radiology have
recommended that yearly screening <font color="#990000"><b><a name="searchTerm"></a>mammography</b></font> begin at age 40. Recent improvements in screening <font color="#990000"><b><a name="searchTerm"></a>mammography</b></font> including digital <font color="#990000"><b><a name="searchTerm"></a>mammography</b></font>
and computer-assisted diagnosis have improved the sensitivity of the
test for some subgroups, challenging the contemporary relevance of
older screening trials (<a href="http://www.accessmedicine.com/content.aspx?aID=3155213#3155213" target="_parent">Pisano, 2005</a>).</p><a name="3155081"></a><p class="contentBody">It
is important to recognize that most women with screen-detected
abnormalities (~95 percent) do not have breast cancer, although the
true-positive rate increases with increasing age (<a href="http://www.accessmedicine.com/content.aspx?aID=3155213#3155213" target="_parent">Feig, 2000</a>).
In addition, up to 25 percent of women diagnosed with breast cancer
will have had a normal mammogram in the preceding 12 to 24 months.</p><a name="3155082"></a><p class="contentHead2">Screening Sonography</p><a name="3155083"></a><p class="contentBody">This
modality identifies mammographically occult breast cancer in less than
1 percent of women, but in one large study this translated into a
42-percent increase in screen-detected cancers (<a href="http://www.accessmedicine.com/content.aspx?aID=3155213#3155213" target="_parent">Gordon, 2002; Kolb, 2002</a>). Screening sonography, however, is time consuming to perform and the accuracy is highly dependent on the operator.</p><a name="3155084"></a><p class="contentHead2">Screening Magnetic Resonance Imaging</p><a name="3155085"></a><p class="contentBody">This
screening option has recently been evaluated among genetically
high-risk women. It is particularly attractive in this group of women,
who develop breast cancer at a rate of 2 percent per year between the
ages of 25 and 50, a time during which <font color="#990000"><b><a name="searchTerm"></a>mammography</b></font> sensitivity is reduced by dense breast tissue. In general, MR imaging shows higher sensitivity and specificity than <font color="#990000"><b><a name="searchTerm"></a>mammography</b></font>, but the test has been criticized for its expense and high false-positive rate (<a href="http://www.accessmedicine.com/content.aspx?aID=3155213#3155213" target="_parent">Leach, 2005; Stoutjesdijk, 2001; Tilanus-Linthorst, 2000; Warner, 2001</a>).
Nevertheless, for 100 women with a strong family history of breast
cancer and a negative mammogram, nine abnormal MR imaging scans would
be expected, and three of these would represent mammographically occult
breast cancer.</p><a name="3155086"></a><p class="contentBody">Breast
MR imaging requires specially trained radiologists, specialized
equipment (a breast coil and a high-resolution magnet), and is
performed with and without intravenous gadolinium contrast (<a href="http://www.accessmedicine.com/content.aspx?aID=3155213#3155213" target="_parent">Orel, 2001</a>).
Areas of suspicious enhancement identified by MR imaging are evaluated
by targeted sonographic examination and biopsied under sonographic
guidance. If a lesion is not visible during sonography, then MR
imaging–guided core biopsy is performed.</p><a name="3155087"></a><p class="contentHead2">Other Radiologic Tools</p><a name="3155088"></a><p class="contentBody">Other
screening modalities in the developmental stage include breast
tomosynthesis, sestamibi scanning, electrical impedance scanning, and
thermography (<a href="http://www.accessmedicine.com/content.aspx?aID=3155213#3155213" target="_parent">Dobbins, 2003; Martin, 2002; Parisky, 2003; Sampalis, 2002</a>).
Of these, breast tomosynthesis warrants special mention, as it is
likely to be adopted into the clinic in the near future. Tomosynthesis
is a digital approach that obtains multiple images as the x-ray source
and collector are rotated around the breast. Image slices are then
reconstructed by a computer. This approach enhances calcifications and
densities that would normally be obscured by intervening dense tissue.</p><a name="3155089"></a><p class="contentHead2">Screening Physical Examination</p><a name="3155090"></a><p class="contentBody">The value of a screening clinical breast examination (CBE) performed by health care providers should not be neglected (<a href="http://www.accessmedicine.com/content.aspx?aID=3155213#3155213" target="_parent">Jatoi, 2003</a>). Four of the large randomized <font color="#990000"><b><a name="searchTerm"></a>mammography</b></font>
trials collected information on CBE and found that 44 to 74 percent of
the breast cancers were detected by this approach. Sensitivity and
specificity were higher for CBE than <font color="#990000"><b><a name="searchTerm"></a>mammography</b></font> among young women.</p><a name="3155091"></a><p class="contentBody">Enthusiasm
for breast self-examination (BSE) has diminished subsequent to
publication of a very large randomized trial performed in Shanghai,
China that found no improvement in mortality (<a href="http://www.accessmedicine.com/content.aspx?aID=3155213#3155213" target="_parent">Thomas, 2002</a>).
Although there is less interest in promoting systematic breast
self-examination, it seems reasonable to encourage women to remain
breast-aware.</p></td></tr></tbody></table></span>
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